How do you treat psoriasis?

Psoriasis like Eczema can initially be treated with creams such as Cetraben or Epaderm, which moisturise and hydrate the skin to reduce dryness. You should avoid the use of soap on your skin as it could cause dry skin to get worse, and instead use products such as Oilatum bath oil or Aqueous cream as soap substitutes. 

Other methods for treating psoriasis include:

• Vitamin D treatments  – these have few side effects, and they work for 73.8% of people who use them at least 2 times daily
• Diet – some studies have shown that alcohol and dairy may lead to flare ups, reducing these can help with symptoms
• Relaxation techniques – stress is a big factor so meditation and relaxation techniques may improve your symptoms
• Combination treatments such as Diprosalic which contain salicylic acid to get rid of dry skin, and a steroid to reduce inflammation
• Coal tar and coconut based treatments such as Sebco or Cocois
• Dithranol
• Topical corticosteroids
• Medicines that reduce inflammation such as ibuprofen or even steroid tablets.

If your psoriasis is particularly bad and not responding to any of the treatments above, you may require immunosuppressants such as methotrexate, or a type of medication known as  Calcineurin inhibitors, which also suppress the immune system. Examples of this type of medication are Tacrolimus or Sirolimus. These medications are either applied onto the skin or as tablets that you swallow and require monitoring more closely over a certain period of time and are prescribed by a specialist dermatologist. 

Light treatment, or PUVA, is also effective in the treatment of psoriasis and many patients note a significant improvement, however there is an increased risk of skin cancer in later life with this treatment so more care has to be taken when going out in the sun.

If these treatments don't work you may need to be seen by a dermatologist. They may suggest more specialist treatments including medicines that suppress your immune system or light treatments.

How does psoriasis treatment work? – psoriasis can’t be cured, so treatment usually works by reducing your symptoms, or stopping them from getting worse. Psoriasis causes growth of scaly skin that can be itchy, painful and dry. We don’t know all the reasons why, but when someone has psoriasis they create more skin cells, and at a faster rate than those without psoriasis. The skin also gets irritated and dry which can lead to bacterial and fungal infections occurring more frequently. Treatments will improve these symptoms by moisturising the skin, improving the inflammation, and slowing down how quickly new skin cells are made. Some treatments, when used for long periods of time, can reduce the number of flare ups you can get in the future.

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What’s the best treatment for psoriasis?

Topical treatments are normally used first – if you have mild-to-moderate psoriasis, topical treatments (treatments which are applied directly to the skin) are the first prescription treatments a doctor would normally recommend. Topical treatments include steroid treatments in combination with salicylic acid such as Diprosalic, or alone such as topical hydrocortisone cream. They can also include coconut and coal tar based products such as Sebco or Cocois. Dithranol and Vitamin D treatments like Dovonex can then be used if these are not effective, as well as topical treatments such as Tacrolimus.

Vitamin D treatments are a good option – this is an effective treatment for people with mild to moderate psoriasis. 73.8% of people who use Vitamin D treatments, like Dovonex, at least 2 times a day will report some of their symptoms improve. It is a topical treatment, which means it won’t cause whole-body side effects in the same way as systemic treatments would. Compared to other topical treatments, like corticosteroids, it’s also less likely to cause side effects.

For more serious symptoms – topical treatments may not be enough if your symptoms are very severe. In this case, you would need to see a specialist dermatologist (skin doctor) who would examine you and suggest other treatment options.

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Can you buy psoriasis treatment online?

Yes, you can buy prescription treatments online – Superdrug’s Online Doctor service can help you get assessment for treatment with topical vitamin D cream. If you have been diagnosed with chronic plaque psoriasis and used Dovonex or a similar treatment before, you can order prescription treatment with us.

What about buying other treatments? – Over the counter treatments such as moisturisers and soap substitutes are readily available over the counter, in some instances you can also obtain a mild topical steroid from your pharmacist. At Superdrug Online Doctor, we only offer certain topical creams for psoriasis. You can get other treatments by speaking to your GP about your symptoms. They can help you get other topical treatments or refer you to a dermatologist for phototherapy if it’s right for you.

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How do you know if you need treatment?

Do I have psoriasis symptoms? – you can’t say for sure that you have psoriasis just from looking. If you do get the typical patches of scaly skin and you’re experiencing symptoms of psoriasis then you might need treatment. However, there are lots of other health conditions that might give you similar symptoms so you can’t know for sure.

How do I get a diagnosis? – in order to get diagnosed with chronic plaque psoriasis, or any other type of psoriasis, you will need to see a doctor. Your doctor will examine you and give you a diagnosis. 

Do you need treatment all the time? – when you have psoriasis, you will be unlikely to have symptoms all the time. Psoriasis symptoms may come and go and these may be referred to as ‘flare ups’. How often you get flare ups may vary from person to person. Flare ups can happen in response to ‘triggers’ which are situations that cause your symptoms to happen. These can be things such as high levels of stress or cold weather.

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Are there any risks to psoriasis treatment?

Risk of side effects – psoriasis treatment can cause side effects, like any other medical treatments. We always advise you to read the patient information leaflet to find out more. 

Treatment with Dovonex can also cause a number of side effects, including:

• Worsening of your psoriasis
• Inflamed, irritated, red, flaky, or itchy skin, similar to eczema
• Pain or a rash where you use your treatment
• Infected hair follicles 
• Dry skin
• Changes to the colour of your skin
• Allergic reaction such as facial swelling and difficulty breathing, or a rash
• Increased blood calcium levels Sensitivity to sunlight
• Swollen skin

What to do about side effects – if the side effects are mild you may find you can tolerate them and are happy to continue. If you don’t think you can put up with them then see your doctor about switching treatments. You can also send your Online Doctor a message through your account if you have any questions about side effects.

Emergencies – you should seek medical help right away if you get any symptoms of an allergic reaction. 

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Sources

Guenther, L. et al (2002). Efficacy and safety of a new combination of calcipotriol and betamethasone dipropionate (once or twice daily) compared to calcipotriol (twice daily) in the treatment of psoriasis vulgaris: a randomized, double‐blind, vehicle‐controlled clinical trial. British Journal of Dermatology, Aug; 147(2): 316-323.

LEO Laboratories Limited (2014). Dovonex ointment. EMC. [online] Available at: https://www.medicines.org.uk/emc/files/pil.981.pdf [accessed 26th September 2018].

National Health Service (2018). Psoriasis. [online] Available at: https://www.nhs.uk/conditions/psoriasis/ [accessed 26th September 2018].

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